Provider Demographics
NPI:1831143379
Name:POLE, CAROLYN MARTIN (LAC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MARTIN
Last Name:POLE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 S KALMIA ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4208
Mailing Address - Country:US
Mailing Address - Phone:760-432-0234
Mailing Address - Fax:
Practice Address - Street 1:337 S KALMIA ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4208
Practice Address - Country:US
Practice Address - Phone:760-432-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4587171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist